Victoria Maizes, MD
Hi, Andy.

Andrew Weil, MD
Hi, Victoria.

Victoria Maizes, MD
Today we have one of our fellowship graduates, the wonderful Dr. Geeta Maker-Clark, who is an expert in culinary medicine.

Andrew Weil, MD
A field dear to my heart.

Victoria Maizes, MD
Yes, it is. And so let's get her on.

Andrew Weil, MD
K

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Victoria Maizes, MD
Dr. Geeta Maker Clark is the director of integrative nutrition and advocacy at Northshore University Health System. She is a clinical assistant professor and the co-director of the Culinary Medicine Program at the University of Chicago School of Medicine. Geeta started the Food Is Power program in Chicago Public Schools. She has been recognized as a national leader in food justice activism with a Castana Fellowship and the Mesa Refuge Michael Pollan Fellowship in Food Journalism. She believes that food plants, dance, music and art are necessary daily medicines. Welcome, Geeta.

Geeta Maker-Clark, MD
Thank you so much for having me, Victoria and Andy.

Victoria Maizes, MD
It's wonderful to have you that last part of your bio makes me think of a Native American teaching which asks patients, When is the last time you sang? When is the last time you danced? When is the last time you told your story? So powerful wisdom.

Geeta Maker-Clark, MD
Yes, that is actually that very saying was so resonant with me that it actually inspired a whole series of workshops that I led around just that.

Victoria Maizes, MD
Yeah. I want to start with some facts which the American Association of Medical Colleges carried out a study and found that medical students get an average of 19.6 hours of nutrition instruction during their medical school careers. And actually, only 28 of 105 medical schools had the required 25 hours. Andy, you sometimes critique that bit of education that they actually get.

Andrew Weil, MD
Yeah, I think nutrition in medical schools is mostly presented as biochemistry and it's forgotten as soon as the biochemistry exams are over. I think you can argue that in this country at least, that most physicians are illiterate in nutrition. It's not their fault they weren't taught it. But it's astonishing that until recently there was not even a place that physicians could go to remedy that and get continuing medical education credit for so it's a great blind spot, and that's one that I think the general public is aware of. There are many others that people are not aware.

Victoria Maizes, MD
So, Geeta, you're one of the people who is trying to remedy that, and you're someone who teaches culinary medicine.

Andrew Weil, MD
What is what exactly.

Victoria Maizes, MD
How is it different from like, what a dietitian like does?

Geeta Maker-Clark, MD
Yeah, absolutely. So first of all, just to tip off to what you were saying there, Andy, I think it's difficult. It's so difficult to understand and parse out how limited the nutrition offerings are in most medical schools, when, the data for the last several decades has identified diet as this, literally the single most significant risk factor for morbidity and mortality in the United States.

Andrew Weil, MD
I've tried to think about, you know, how can that be that something so fundamental to health gets so neglected. And the only explanation I can think of is that to the academic medical mind that I'm tempted to say to the male academic medical mind, nutrition looks like home economics. It does not look like biochemistry or pharmacology or what people think of as real science. And so it always gets short shrift.

Geeta Maker-Clark, MD
I agree with you, and that is a good segway into what culinary medicine is, because I think the field is was created to address all those missed opportunities that were presented by nutrition education at really all levels of medical education and in medical practice. And currently, like you said, Victoria, you know, the nutrition offerings are really limited in their time, in their scope, in their content.
They're almost inapplicable to direct patient care because, a lot of this stuff is taught in preclinical years. The students aren't even seeing patients yet, and then they're learning about nutrient deficiencies. You know, that's not talking about food right? And you can't talk about nutrition without talking about food. And then you start getting into that feeling, Andy of like, you know, maybe this has a more Home EC feel.

Geeta Maker-Clark, MD
And I'm actually proud and happy to say I think culinary medicine is coming in, stepping into that home economic space. Great that, you know, we need to bring back. But what is it? It is a in evidence based field of medicine that combines nutritional science and culinary arts to create food that is delicious, that promotes wellness and that prevents and treats disease.
And it's very hands on. It's very practical and brings students and community into kitchens to learn how to prepare delicious, healthy food and also learn some key nutrition points and kind of shift away from this focus on nutrients and more focus on food.

Andrew Weil, MD
So where is it available? How do people access culinary medicine, education?

Geeta Maker-Clark, MD
the way that it was kind of initiated was through the medical schools. And right now, I'm happy to say there's programing in more than 60 academic medical centers across the United States, it's probably even more than that because it's really taken off. And there's been some very outstanding results documented even in the last few years showing positive outcomes and competencies around food and lifestyle interventions.

So in medical school, there's a 50/50 chance now that you're going to go to a school that's offering either an elective or a has embedded it into the curriculum. And then some of the schools are with some philanthropic aid, are building teaching kitchens and really starting to understand the importance of making sure patients and students are learning some of the most fundamental aspects of health, right? Like how do we feed ourselves?

Andrew Weil, MD
Victoria what is our Center doing in this area?

Victoria Maizes, MD
I'm so excited because we are going to have a teaching kitchen in our new complex, which we have not had until now. And so that really wildly opens the opportunity that we have. We certainly focus in our fellowship and our integrative medicine residency on teaching culinary medicine. And one silver lining of the pandemic is that when everyone's at home in their own kitchen, you actually can teach cooking and have them cook along and ask questions and learn stuff.
And so Andy's done a lot of teaching in his kitchen and taught fellows how to cook different things. One of our graduates, an OBGYN named Annie Kennard, has done this in our integrative medicine and residency. And so I think everyone has just loved that. But I actually want to step back a tiny bit because, Andy, you've always been passionate about cooking. You actually have a chain of restaurants, but I'm wondering what made you see the importance of food as critical to good health? Before there were these reports in the U.S. health system that what we eat matters. I mean, you were on this early.

Andrew Weil, MD
Well, I had an interesting aunt, my mother's older sister, who was unmarried. She was a schoolteacher, and she had charge of me on Saturdays when both my parents worked. And she was a health nut and she would try to indoctrinate me in her way so she would take me there was one health food store in downtown Philadelphia, so she would take me there. She introduced me to things like raw cashews and mangoes and avocados. She was the first person I knew who had a blender, and I remember her saying she would put a whole pineapple in the blender top and all. And so there were a lot of nutrients in the top to drink this stuff and all these spikes with sticking, you know, some of what she taught me, I remember that was useful, but I think that was my first, introduction to thinking about the importance of food and its relationship to health.

Victoria Maizes, MD
Now, are you saying that we owe integrative medicine to your aunt? At least tell us her name?

Andrew Weil, MD
Rebecca, Aunt Rebecca. And so, yes, she had a great influence on me. And then, you know, as I got into my college years, it was so awful, the kind of institutional food that I remember. And, you know, I always wanted to learn how to cook. And my mother would kick me out of the kitchen saying, you know, I should be outside playing.

Andrew Weil, MD
But my father's grandmother, who lived with us from time to time, would let me assist her in cooking. And then I began to hang around people who cooked, and I just learned by observing.
Victoria Maizes, MD
So some of this knowledge came to you during your childhood, and Geeta, I know that you have been involved with the Chicago Public Schools. What approach do you use to help children learn about healthy food? You know, sometimes they haven't really been exposed to cooking either because they're getting processed foods or fast foods. What do you do?

Geeta Maker-Clark, MD
When I was teaching culinary medicine to medical students, I kind of realized, first of all, it's very rewarding. It's super enjoyable. The med students love it. As you can imagine. It's a chance for them to just, kick back and really focus on themselves and really get an opportunity to eat together and commune and all the beautiful things that cooking and eating together bring in community.

But I also realized, these students are, for the most part in their twenties, some are in their thirties. And for many of them, this was like the first time they were having a chance to work in a kitchen with a chef or, be able to share an experience like this. And I felt like, gosh, this is kind of late.

I would love us to be teaching this kind of a model in grade school, and have this be a part of the fabric of American society. Because I think what we've lost, you know, it's it's so sweet to hear your story, Andy. And I'm impressed to your ancestors because they made you who you are and the result of you.

I get to be who I am so I think it's vital that we look to those times where there was just a real culture around food and teaching food and passing on of tradition and a lot of modern life has really been robbed of that. And a lot of kids have been robbed of those experiences for so many reasons.

You know, parents are hustling, they're working jobs, they're not home as much. The food costs have gone up. It's just challenging for for Americans in particular. So it's you know, it felt important to me that the schools need to be taking some responsibility around this as well, and that all of us doctors, physicians, health care professionals, we all need to be taking some responsibility for bringing back the culture of eating well, and that's in all of our realms and responsibilities to do so. So I asked the medical students, listen, will you come with me to teach this class in Chicago Public School? And they were super excited and game I love medical students. I feel like they're still so they're so. Optimistic

Victoria Maizes, MD
And idealistic. Yeah.

Geeta Maker-Clark, MD
So idealistic and so in it for the service really, you know, really in it for the service. So we we piloted this program in one of the Chicago Public Schools, and I have many programs that I call food as medicine. And so I called it that. And that first day I had this this group of seventh graders, and I was like, Hey, so I'm going to be teaching this class Food is medicine.
I'm Dr. Geeta. These are my students. I have a beautiful chef who works with us as well. And I said, What do you guys think about when you think of the word medicine? You know, what's the first things that come to your mind and, you know, hands are going up, “Pills”

Andrew Weil, MD
Pills.

Geeta Maker-Clark, MD
Shots, you know, diabetes. My grandma goes to the doctor when she's sick. Hospitals write all these words that come up. Of course they do. That's what we all think of when we think of medicine. And, you know, of course, my philosophy and both of yours, I know from our integrative medicine mind scape is that there are so many medicines around, there's food and plants and dance and all the things, you know, we were talking about. So I realized, you know, medicine, the paradigm needs to shift, number one. Number two, this word isn't really the right word for this class because it's not speaking to these kids. And I changed it to food is power. And I thought, you know, maybe this will be a place where they can learn that you got to make powerful choices for yourself.

Geeta Maker-Clark, MD
Once you know something about food, that's wonderful. We have a total blast. You know, it's a teaching kitchen that comes to them. I, I bring all the stuff. The chef brings food and a hot plate and our blenders and whatever we can manage for the recipes into their cafeteria, and we're located in an area of Chicago. I specifically chose a school in Chicago that is really affected by what I call food apartheid.

I don't I don't like that term food desert. I don't think it's very accurate. It implies a natural ecosystem where there are naturally abundant places and naturally, drought like insufficient places. And that's just not the the truth. Right. There are reasons there that we don't have really good quality food in all of the United States is because of structural racist policies that have created these spaces. So going into a neighborhood like that where there's not a lot of grocery stores, there's mostly corner stores, there's a lot of processed food, I was hoping to say, Hey, you guys, tell me what you eat. You know, I'm not coming here to tell you, like, you should start eating kale and quinoa. But I'm here to say, what do you guys eat? And let's share information and let's cook together and make things that you guys think are yummy and also healthy. And then you tell me if you think they're good. And we kind of it's very bidirectional. It's really community oriented. And something very interesting to me was that a lot of these kids are cooking for their siblings, a lot of them by seventh grade in eighth grade.

Victoria Maizes, MD
Wow.

Geeta Maker-Clark, MD
So that's some of the interesting learning points for me are that they are experts in their life. And I'm there to be an expert in what I am, but not to kind of come in and say, you need to change everything you're doing.

Victoria Maizes, MD
Geeta just mentioned kale is a food that these kids might not want to eat. I'm interested to hear what your strategies have been to help kids eat healthier.


Andrew Weil, MD
Well, I can only make food that is appealing to them. That's delicious, that tastes good. And I also have found it useful to involve kids from an early age in food preparation. my own daughter Diana was not real interested in cooking, and now she's become a terrific cook. So it's a gradual process. Geeta I want to ask you about hospital food and institutional food, which is it's a very sad story I made an effort some years ago to improve the food at the University of Arizona Medical Center cafeteria. I got nowhere. I was completely stonewalled. I thought I was going to run into problems with a registered dietitian, but that was not the obstacle. The obstacle was the food service providers. And these are these big corporations. There's just a few of them that have a lock hold on food and prisons, in senior facilities, and hospitals.

No, you know it's companies like Marriott, for example. And and they came to the meetings that I organized and anything I suggested they saw as a threat to their bottom line profit and they wouldn't change anything.
Geeta Maker-Clark, MD
Hmm. Yeah, that's been that was my experience too, for a while. And I sat in on probably four years of meetings before we started to make some progress. And I will tell you, I've been able to make some really significant progress in our four hospital system in the Chicago area, and it did have to come through those food service providers, but there had to be an institutional intention around really wanting that to change.

And I think that's when what really started to make the difference is I picked one thing, I was like, there's a million problems here, like sugar sweetened beverages. Food tastes terrible, there's a million problems. And I can't …I can't solve them all, but I'm going to pick one thing. And one of those things that really got my goat was that the meat quality was so bad, I don't even eat meat. But the idea that, like we're serving really like bad quality meat to sick people in hospitals feels just wrong. These are animals that have antibiotics and hormones and pesticide in them. Their stress, their cortisol levels are high. And so I went after that. I said, if you could do one thing, just change the meat to antibiotic free meat, get some good quality meat in the hospital.

Geeta Maker-Clark, MD
And I got the infectious disease folks to talk about antibiotic resistance and how that plays into the food that we eat, how it's a result of the food that we eat and got them on board. And we did a cost analysis and were able to very slowly move that needle to convert the hospital to antibiotic free meat over a couple of years.

And then when that happened there was a bit of a buy in. We switched Meatless Mondays and plant based Thursdays. And little by little there have been some shifts and I feel really good about where.

Andrew Weil, MD
Yeah, that's a very good strategy of picking one thing to work on and I found that to be useful as well.

Geeta Maker-Clark, MD
Yeah. And you know, there's we have a long way to go yet in hospital food and in school food. And I think if we change those two things we could make a dramatic impact on people's lives.

Andrew Weil, MD
Yeah. When I look at our country in general and the nutritional mess we're in, the one thing that I would pick is to get people to stop drinking sweetened liquids. Yes. it's not just soda, it's energy drinks. It's fruit juice. It's putting sugar in coffee and tea. It's all of that. That one step would put us ahead of the curve and we could then go from there in other directions.

Geeta Maker-Clark, MD
Yeah, I totally agree.

Victoria Maizes, MD
So both of you have spent a lot of time in other countries around the world and have been influenced in your thoughts about food and nutrition. Maybe start Andy with you. What society influenced you the most?

Andrew Weil, MD
Well, Japan, certainly, where I've spent a lot of time also Italy, India, one observation about Italy, and I think this applies to France, too, although I've spent less time there, I have known many Americans who are very concerned about weight, who've gone on holidays to France and Italy especially, and decided they were just going to throw caution to the winds and eat anything they wanted. And they said they kept up their activities were physical activity was about the same as it's always been. They came back home after two or three weeks expecting to find that they gained, a bunch of weight and they'd actually lost weight. Now, that's really interesting. I've heard this from enough people that what's different I mean, I think the food is different, the quality of food is different. The attitude of eating it is different. But that's a very interesting observation. You know, what are we doing wrong here? I think the quality of food being much better is a big one. I think when you're when you're served low quality food and it doesn't satisfy you, you're inclined to eat more of it, larger quantities. You're trying to get satisfaction. Or also, if you're not paying attention to eating, if you're sitting in front of a television or at a drive in in those countries in Europe, I think people focus on eating and take pleasure from it. And they're not looking at the nutrient content. This is going to increase cholesterol. You know, it's, I think, a much better attitude.

Victoria Maizes, MD
So I completely agree with you. And as you know, I'm really interested in environmental health and certainly in the European Union the laws outlaw things like Roundup Ready that we spray on our crops. And some of those environmental toxins are what we call endocrine disruptors, and some of them are what we now call obesigins, which means they predispose you to gain weight. And I think traveling to places where that's just not a factor in your food could be relevant to this example you just gave of people throwing caution to the wind and it doing well.

Geeta Maker-Clark, MD
I remember learning about the French school lunch program.

Andrew Weil, MD
Uh huh, yeah. Yeah.

Geeta Maker-Clark, MD
So this is so moving to me. It actually was when I found out how well the French feed their children. I it's part of what shifted me into this work with kids as well, because first of all, it shows that we can do better because, they have the political will to feed their children. Well, And why do they do that? Well, they have a culture of food. What food means a lot to people in France. You know, it's not just a way of getting nutrients or calories or just something you eat on the run, like people sit down and they eat and they eat with each other and they talk and converse. And it's a real true culture. And that culture has to be taught, right?

It has to be taught to continue. And so kids in France, even in very poor villages, are getting three and four course meals at their public school lunches. And they're mostly vegetables, a wide variety of vegetables, certainly not anything you'd call kid food, like a kid meal food like chicken nuggets or, you know, mozzarella sticks or whatever. It's food that any of us would probably eat and enjoy. And I love that about, you know, the sort of intentionality of saying that there's culture and belonging and a culture of care that needs to be infused into our food systems. You know, I don't even like the word food system, to be honest. I find it very reductionist and kind of sterile.

But the idea that, you know, the way that we speak about food has to be about nourishment and values. And I think the French do that well. And the Italians, yeah.

Andrew Weil, MD
Geeta In Italy, I've driven a bunch in Italy and on the Alto Strada by the freeways, there are the rest stops. It's a chain, it's all the same thing. And you go into one of these rest stops, incredible salad bars, fabulous bread, beautiful pasta, extra virgin olive oil. Why do we put up with what we have here? So if I'm on if I'm at an interstate and stop at a rest stop, I'm lucky if I can get a bag of peanuts that don't have anything bad in them.

Andrew Weil, MD
I mean, really, that's it. Otherwise, it's, you know, the bright blue slush going around and the thing and all processed food. Um, why do we stand for that? Same with food in the airports here, why do people put up with it right?

Geeta Maker-Clark, MD
I know. I think we've we've become very deeply conditioned into this capitalist framework and and we really need to take a look at what's possible. And actually, I do feel very optimistic, though, Andy, I'll tell you, first of all, I try to stay optimistic.

Andrew Weil, MD
Yeah, sure.

Geeta Maker-Clark, MD
Otherwise, what are what's going to become of us if we don't stay out too?

Andrew Weil, MD
Yeah.

Geeta Maker-Clark, MD
And it really takes work to stay optimistic every day. And I take it seriously to be that way. But there actually is some real reason to be optimistic right now in the sense that you probably both heard there was a White House conference on hunger and nutrition in September. A lot of our integrative medicine folks were there, there's a very serious commitment financially and otherwise from this administration towards improving health through food and improving our food culture over the next several years. And it's pretty ambitious. I mean, they're looking at 2030 to see some decreased hunger outcomes. I mean, hunger is a whole sort of separate topic to some degree. But I do think we do have a public that is seeing that this isn't right, Right. That it's not right for us to be eating this way. And regardless of how well our hospital systems and our interventional medicine has advanced, that our rates of chronic disease keep going up people get it, they're like, we need to change something. And I feel buoyed that the government is feeling that as well. And seeing that doing something about it, because we do need we need there to be will a will for things to change on all levels - food industry, government, medicine, all of us need to be working towards this.

Victoria Maizes, MD
So you mentioned over the course of this conversation a couple of bright spots. There is the work you're doing in Chicago public schools. There is the administration's commitment to better funding of our school lunches. education for health care professionals. What other bright spots are you seeing? I mean, I actually am encouraged, for example, that there are a lot of community gardens and there are collaborations sometimes here in Tucson, there's a collaboration between the public schools and the community gardens and the University. That's exciting. There are some wonderful, healthy, fast food. You know, fast food has a bad name, but I think, you know, there is now some chains that are providing food that you'd want to eat.

Geeta Maker-Clark, MD
Yeah. I do also see many bright spots. I agree with you that these community collaborations are very important. Culinary medicine certainly didn't invent cooking classes. Right, Right. Been going on in communities for decades. And so partnering with communities, academic community partnerships, private public partnerships, I think are such a beautiful place that we're seeing a lot of growth both philanthropically and from federal funds as well.

That's where the solution is. We have to be cross-pollinating our ideas. We have to be stepping in our communities and seeing what people want and need and then being in it with them and not have our systems be so hierarchical. Right? So a community garden that's in collaboration with the Culinary Medicine program, that's in collaboration with an academic center, this is a this is a beautiful space to be. And it's very mycelial, You know, it's like we have to have a mycelial framework of how we can all be an underground support system for each other. Something else I think is worth mentioning is that the payers are starting to reimburse for food more than they ever have before. I think that's always been a hope.

When we had the products, prescription programs are growing, medically tailored, meal programs are growing. But for many of us sitting in our offices, you want to be able to help our patients and have the knowledge to be able to help them around nutrition. There's still not the ease of saying, gosh, I wish I could just write you a prescription and go to the grocery store and buy all these things and it be covered, you know?

And I think we're getting closer to that. I was just adding a really fascinating conference last week, a Food is Medicine Summit. That was interestingly, usually I go to these things and it's a lot of health care folks. And this time it was mostly business people and people who are kind of stakeholders in this new scramble to get a piece of what the Food is Medicine movement's going to look like. I saw some really interesting technological apps that are very user friendly for patients to be able to scan food, for instance, and see if it has any of the allergens that they particularly have or to see if their insurance will cover it. But one thing I learned at this conference is that, we have and we have SNAP, and most people don't use the benefits they already have in these programs.
Medicare Advantage also covers like 270 meals per year post-discharge from surgery. Or if you have a chronic condition such that you can't purchase your own food or prepare it. So I do think for listeners to look into who your providers are and to see what kind of coverage you might have for food related purchases can be a place where we're helping people get more access and improving food equity and health equity and getting us all closer to just being able to use food as medicine on a daily basis.

Victoria Maizes, MD
Yeah those are some really encouraging signs of positive change. Geeta or Andy, any final thoughts that you want to add.

Andrew Weil, MD
It's been a long time coming and I'm delighted to see this movement taking shape. I'm very pleased that our center is going to be participating in it. It's a wonderful trend.

Geeta Maker-Clark, MD
I would add that culinary medicine is a different a different type of vocabulary. But I really think of it as an arm of our integrative model of medicine and well-being. Right. It really is part of integrative medicine at its core. And  I'm so delighted about that. But I hope that we can be in better kinship with our food and our communities. And rather than push and not yet another field of medicine, that we can compartmentalize in a different way, that we continue to amplify the culture of care and community and ecosystem that keeps us all connected and healthy.

Victoria Maizes, MD
Well, Geeta, thank you so much for the work that you're doing to to change the world in those ways. So we so appreciate having you on as a guest and all the work you're doing.

Geeta Maker-Clark, MD
Thank you. Thank you for having me and thank you for teaching me.

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